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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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Figure 9-6 illustrates the two complementary theories of how IV regional anesthesia produces a block. It conceptualizes the local anesthetic entering the venous system and producing the block by blocking the peripheral nerves running with the venous structures. It also outlines a theory that may be complementary; that is, the local anesthetic leaves the veins and blocks small distal branches of peripheral nerves. It is likely that both of these theories are operative. If IV regional anesthesia is to be used successfully, all members of the operating team should understand the importance of tourniquet integrity, as the most significant problems with the technique involve unintentional deflation of the tourniquet.

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Figure 9-6  Intravenous regional block: potential mechanism(s) of action.

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